Provider Demographics
NPI:1700224029
Name:REEVE, KATHARINE ROOSEVELT (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:ROOSEVELT
Last Name:REEVE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 WILMINGTON DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-6103
Mailing Address - Country:US
Mailing Address - Phone:970-416-9009
Mailing Address - Fax:970-416-9010
Practice Address - Street 1:1927 WILMINGTON DR UNIT 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-6103
Practice Address - Country:US
Practice Address - Phone:970-416-9009
Practice Address - Fax:970-416-9010
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000851213E00000X
IL135000818213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program